Ultrasound imaging is a ubiquitous diagnostic technique, but does not fit the requirements of the telemedicine approach, because it relies on the real-time manipulation and image recognition skills of a trained expert, called sonographer. Sonographers are only available in hospitals and clinics, negating or at least delaying access to ultrasound scans in many locales—rural areas, developing countries—as well as in medical rescue operations. Telesonography would require an advanced imager that supports three-dimensional (3-D) acquisition; this would allow untrained operators to acquire broad scans and upload them remotely for diagnosis. Such advanced imagers do exist, but do not meet several other requirements for telesonography, such as being portable, inexpensive, and sufficiently low power to enable battery operation. In this work, we present our prototype of the first portable 3-D digital ultrasound back-end system. The prototype is implemented in a single midrange Xilinx field programmable gate array (FPGA), for an estimated power consumption of 5 W. The device supports up to 1024 input channels, which is state of the art and could be scaled further, and supports multiple image reconstruction modes. We evaluate the resource utilization of the FPGA and provide various quality metrics to ascertain the output image quality.